Stress and Adaptation

a word taken from the term "distress." The process of responding to stress is constant and dynamic and is essential to a person's physical, emotional, and social well-being. Stress is a major component in health and illness. Nurses need to understand the concepts and lvls of stress when providing nursing care to pts in all settings. Nurses themselves are subject to stress from the demands of their career, and need to know healthy ways of responding. Stress is a condition in which the human system responds to changes in its normal balanced state. Results from a change in the environment that is perceived as a challenge, a threat, or a danger. Not only is stress a part of everyday experience, but a person's responses to stress are also necessary to life. Stress affects the whole person in all the human dimensions, positively or negatively. The perception of stress and the responses to it are highly individualized, but also from one time to another in the same person. Each person's perception of and responses to stress are structured by his/her culture, family, genetic inheritance, and life experiences.

anything that is perceived as challenging, threatening, or demanding. Stressors may be internal or external. As with stress, the perception and effects of the stressor are highly individualized. Stressors themselves are neither positive nor negative, but they can have positive or negative effects as the person responds to change.

When a person is in a threatening situation, immediate responses occur. Those responses, which are often involuntary, are called coping responses.

The change that takes place as a result of the response to a stressor. Adaptation is, to some degree, an ongoing process as a person strives to maintain balance in his or her internal and external environments. Adaptation also occurs in families and groups. Adaptation is necessary for normal growth and development, the ability to tolerate changing situations, and the ability to respond to physical and emotional stressors.

is a localized response of the body to stress. It involves only a specific body part (such as a tissue or organ) instead of the whole body. The stress precipitating the LAS may be traumatic or pathologic. LAS is a primarily homeostatic short-term adaptive response. Although the body has many localized stress responses, the two most common responses that influence nursing care are the reflex pain response and the inflammatory response.

a response of the central nervous system to pain. It is rapid and automatic, serving asa protective mechanism to prevent injury. The reflex depends on an intact, functioning neurologic reflex arc and involves both sensory and motor neurons.

is a local response to injury or infection. It serves to localize and prevent the spread of infection and promote wound healing. When you cut your finger, for example, you often develop the symptoms of the inflammatory response—pain, swelling, heat, redness, and changes in function.

is a biochemical model of stress developed by Hans Selye (1976). The GAS describes the body’s general response to stress, a concept essential in all areas of nursing care. The three stages in the GAS are alarm reaction, stage of resistance, and stage of exhaustion. Although the alarm stage is short term (minutes to hours), the length of the resistance and exhaustion stages varies greatly, depending on such variables as the severity and duration of the stressor, the previous health of the person, and the immediacy and effectiveness of healthcare interventions. The GAS is a physiologic response to stress, but it is important to remember that the response results from either physical or emotional stressors. The stages occur with either physical or psychological damage to the person. Obvious alertness. (If you recall the last time you almost had a car crash, you can easily identify these body reactions!) During the second phase of the alarm reaction, countershock, there is a reversal of body changes.

• -backache
• -constipation/diarrhea
• -dilated pupils
• -dry mouth
• -h/a
• -incr urination
• -incr pulse, bp, and respirations
• -nausea
• -sleep disturbances
• -stiff neck
• -incr perspiration
• -chest pain
• -weight gain/loss
• -decr sex drive

• • Invasive or health-related tests or examinations
• • Surgical procedures
• • Diagnosis of chronic illnesses, including diabetes, cancer, and cardiovascular diseases
• • Declining physical and/or mental capabilities
• • Retirement
• • Loss of spouse and/or significant others
• • Increased social isolation
• • Chronic pain
• • Alcohol abuse
• • Loss of independence in living arrangements, driving, and activities of daily living

physiologic alterations and illness believed to be due to psychological influences.

defined as an event in a person’s life that requires energy for adaptation. When energy is expended to adapt to the event, the person’s resistance to illness is lowered. For example, although a holiday celebration with family and friends is considered a positive event in one’s life, stressful factors include the time necessary to prepare for the party, worrying about how everyone will get along, and trying to decide how much money to spend.

Is the most common human response to stress. Is a vague, uneasy feeling of discomfort or dread from an often unknown source. It's also a feeling of apprehension caused by anticipating a danger. Anxiety is experienced at some time by all people and can involve one's body, self-perceptions, and social relationships. It is an altering signal that warns of impending danger and enables the individual to take measures to deal with threat.

(a feeling of dread) is a cognitive response to a known threat.

is present in day-to-day living. It increases alertness and perceptual fields (e.g., vision and hearing) and motivates learning and growth. Although mild anxiety may interfere with sleep, it also facilitates problem solving. Mild anxiety is often manifested by restlessness and increased questioning. At a mild lvl, anxiety can have a positive effect, but anxiety beyond that lvl is generally negative and has unpleasant effects. In an attempt to neutralize, deny, or counteract the anxiety, the person develops individual patterns of coping.

Moderate anxiety narrows a person’s perceptual fields so that the focus is on immediate concerns, with inattention to other communications and details. Moderate anxiety is manifested by a quavering voice, tremors, increased muscle tension,a complaint of “butterflies in the stomach,” and slight increases in respirations and pulse.

Severe anxiety creates a very narrow focus on specific details, causing all behavior to be geared toward getting relief. The person has impaired learning ability and is easily distracted. Severe anxiety is characterized by extreme fear of a danger that is not real, by emotional distress that interferes with everyday life, and by avoiding situations that cause anxiety. It is manifested by difficulty verbally communicating, increased motor activity, a fearful facial expression, headache, nausea, dizziness, tachycardia, and hyperventilation.

causes the person to lose control and experience dread and terror. The resulting disorganized state is characterized by increased physical activity, distorted perception of events, and loss of rational thought. Panic is manifested by difficulty communicating verbally, agitation, trembling, poor motor control, sensory changes, sweating, tachycardia, hyperventilation, dyspnea, palpitations, a choking sensation, and sensations of chest pain or pressure. The person is unable to learn, concentrates only on the present situation, and often experiences feelings of impending doom. This level of anxiety can lead to exhaustion and death.

Anxiety often is managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety. Many coping behaviors are learned, based on one’s family, past experiences, and sociocultural influences and expectations. Coping behaviors can be negative/positive.

• • Crying, laughing, sleeping, cursing
• • Physical activity, exercise
• • Smoking, drinking
• • Lack of eye contact, withdrawal
• • Limiting relationships to those with similar values and interests

Coping mechanisms often used at higher levels of anxiety are categorized as task-oriented reactions. Task-oriented reactions involve consciously thinking about the stress situation and then acting to solve problems, resolve conflicts, or satisfy needs.These reactions include attack behavior, withdrawal behavior, and compromise behavior.

occurs when a person attempts to overcome obstacles to satisfy a need; it may be constructive, with assertive problem solving, or destructive, with feelings and actions of aggressive anger and hostility.

involves physical withdrawal from the threat, or emotional reactions such as admitting defeat, becoming apathetic, or feeling guilty and isolated.

is usually constructive, often involving the substitution of goals or negotiation to partially fulfill one’s needs.

other unconscious reactions to stressors. These mechanisms protect one’s self-esteem and are useful in mild to moderate anxiety. When extreme, however, they distort reality and create problems with relationships. At that point, the mechanisms become maladaptive instead of adaptive. These include compensation, denial, displacement, introjection, projection, rationalization, reaction formation, regression, repression, sublimation, and undoing.

A person attempts to overcome a perceived weakness by emphasizing a more desirable trait or overachieving in a more comfortable area.

A person refuses to acknowledge the presence of a condition that is disturbing.

A person transfers (displaces) an emotional reaction from one object or person to another object or person.

A person incorporates qualities or values of another person into his or her own ego structure. This mechanism is important in the formation of conscience during childhood.

A person’s thoughts or impulses are attributed to someone else.

A person tries to give a logical or socially acceptable explanation for questionable behavior(“behavior justification”).

A person develops conscious attitudes and behavior patterns that are opposite to what he or she would really like to do.

A person returns to an earlier method of behaving.

A person voluntarily excludes an anxiety-producing event from conscious awareness.

A person substitutes a socially acceptable goal for one whose normal channel of expression is blocked.

An act or communication used to negate a previous act or communication.

• physiologic:
• *change in appetite, activity, or sleep
• *change in elimination patterns
• *incr pulse, respirations, BP
• safety/security:
• *feels threatened/nervous
• *uses ineffective coping mechanisms
• *is inattentive
• love/belonging:
• *is withdrawn and isolated
• *blames others for own faults
• *demonstrates aggressive behaviors
• *becomes overly dependent on others
• self-esteem:
• *becomes a workaholic
• *exhibits attention-seeking behaviors
• self-actualization:
• *refuses to accept reality
• *centers on own problems
• *demonstrates lack of control

Caring for a family member at home for long periods can also cause prolonged stress. Called caregiver burden, this stress response includes chronic fatigue, sleep problems, and an increased incidence of stress-related illnesses, such as high blood pressure and heart disease.

is a disturbance caused by a precipitating event, such as a perceived loss, a threat of loss, or a challenge, that is perceived as a threat to self. Crises may be maturational, situational, or adventitious.

occur during developmental events that require role change, such as when a teenager moves into adulthood.

occur when a life event disrupts a person’s psychological equilibrium, such as loss of a job or death of a loved family member.

are accidental and unexpected events, resulting in multiple losses and major environmental changes, such as fires, earthquakes, and floods, that involve not only individuals, but also entire communities.

• occurs as a person progresses through the normal stages of growth and development from birth to old age. Within each stage, certain tasks must be achieved to resolve the crisis and reduce the stress. Examples associated with developmental stress include the following:
• • The infant learning to trust others
• • The toddler learning to control elimination
• • The school-aged child socializing with peers
• • The adolescent striving for independence
• • The middle-aged adult accepting physical signs of aging
• • The older adult reflecting on past life experiences with satisfaction

• can occur at any time,although the person’s ability to adapt may be strongly influenced by his or her developmental level. Examples of situational stress, which may be either positive or negative, include the following:
• • Illness or traumatic injury
• • Marriage or divorce
• • Loss (belongings, relationships, family member)
• • New job
• • Role change

Physiologic stressors have both a specific effect and a general effect. The specific effect is an alteration of normal body structure and function. The general effect is the stress response. Primary physiologic stressors include chemical agents (drugs, poisons), physical agents (heat, cold, trauma), infectious agents (viruses, bacteria), nutritional imbalances, hypoxia, and genetic or immune disorders. There are an almost infinite variety of psychosocial stressors, which become so much a part of our daily lives that we often overlook them. They include both real and perceived threats. The person's responses are continuous and include individualized coping mechanisms for responding to anxiety, guilt, fear, frustration, and loss. The mechanisms serve to maintain psychological homeostasis. Examples of psychosocial stressors include: accidents, stressful/traumatic experiences of family members and friends, horrors of history such as Nazi concentration camps, fear of aggression/mutilation such as muggings/rape/murder/terrorism, events of history that are brought into our homes through TV such as wars/earthquakes/violence in school, and rapid changes in our world and the way we live including changes in economic and political structures and rapid advances in technology.

one's physiologic reserve and genetic inheritance are important in maintaining homeostasis and adapting to stressors. the ability to adapt is decreased in the very young, the very old, and those with altered physical or mental health, who do not have the necessary physiologic reserve to cope w/ physical changes, such as dehydration or fluid excess. Adequate nutrition and sleep are necessary for enzyme function, immune responses, wound healing, and energy production and restoration. Malnutrition, dietary deficits/excess, and sleep deprivation all impair one's ability to adapt to stress. Social factors and life events are also implicated in adaptation to stress, with people who have strong support systems and relationships better able to adapt to stress and remain healthy.

complex of behaviors. can be compared with the exhaustion stage of anxiety and is characterized by a wide range of behaviors.

cardiac dysrhythmias, chest pain, h/a, hyperventilation, diarrhea, tense muscles, and skin lesions, such as eczema.

• -use a calm, reassuring approach
• -explain all procedures, including sensations likely to be experienced during the procedure
• -stay with the pt to promote safety and reduce fear
• -listen attentively
• -encourage verbalizations of feelings, perceptions, and fears.
• -instruct pt on the use of relaxation techniques.
• -assess for verbal and nonverbal signs of anxiety.

Heighten arousal and increase energy.

Ineffective individual coping

Mind- or mood-altering substances to cope with stress.

Cortisol